Smile Pretty: Common Dental Problems and Treatments

As I waited in the dentist's chair for my root canal, I closed my eyes and tried to imagine myself on a tropical island. But my heart continued to race. Thanks to an extreme case of dental phobia, I'd let a toothache linger for almost a year, hoping the pain would disappear. Now it was time to co-pay the piper.

This may sound extreme, but my fears aren't uncommon. Thirty to 40 million Americans steer clear of the dentist each year due to anxiety, according to the American Dental Association (ADA).

Turns out my worry was for naught. The root canal took less than an hour—and didn't hurt at all. I was so pleasantly surprised that I hugged my dentist afterward.

New technologies have made dental procedures shorter, and state-of-the-art instruments mean less discomfort. Plus, dentists are acknowledging patient stress. "We talk to people extensively now before sticking anything in their mouths," says Kimberly Harms, D.D.S., a dentist in Farmington, Minnesota, and a consumer adviser spokesperson for the ADA. "We ask what they're concerned about and answer their questions, which establishes trust."

Before you brush off your dental distress, find out why the experts say the latest fixes for common problems are bound to leave you smiling.

Toothache

This throbbing sensation is usually the result of decay. When a cavity is left untreated, it deepens and exposes the tooth's inner pulp (where the nerves are), leaving it vulnerable to irritation and infection, says Jerry Gordon, D.M.D., a dentist and CEO of The Dental Comfort Zone in Bensalem, Pennsylvania. "Once it reaches the toothache stage, it's typically too late for a simple filling." Your dentist (or an endodontist, who specializes in matters concerning the inside of the tooth) will need to perform surgery: either a root canal, which replaces the tooth's damaged pulp with a rubbery material, or in severe cases, an extraction.

The good news: Rotary dental files—metal instruments that attach to a drill—make root canals easy. "The latest ones are made of a nickel-titanium alloy instead of stainless steel. They're just as strong but more flexible, so the job can be done faster, without putting as much pressure on your teeth," says Dr. Gordon. Getting a tooth pulled isn't the nightmare it used to be, either, because of improved anesthetics. Ask about your options. Many dentists now use Articaine, a shot with twice the concentration of other anesthetics, providing more intense numbness and penetrating further into the teeth, jaw and gums. It also starts working faster and wears off more quickly, meaning you can eat soon after.

Price point: A root canal costs $600 to $1,400, depending on which tooth is treated (back molars are the most expensive). See your dentist first, and if he's unable to do the procedure he may refer to you an endodontist. Many dental insurance plans cover 80% to 100% of the cost of root canals. A tooth extraction will set you back a couple of hundred, though insurers are likely to provide partial coverage.

Grinding

Most experts believe emotional stress is a factor in teeth grinding, temporomandibular joint disorder (TMJ) and clenching (bruxism), which for some reason affect more women than men. "It can begin with any type of worry or when someone starts a new job or experiences the death of a loved one," says Dr. Gordon. "Self-detecting the condition is difficult because most people who grind or clench do it while they sleep." Look for telltale signs, like flattened or chipped teeth, and sore facial muscles in the morning. And get treatment as grinding can lead to cavities, jaw pain, headaches and tender gums.

The good news: Mouth guards can protect your teeth and provide relief in as little as two weeks by reducing friction between your top and bottom rows of teeth. "The new dual-laminate acrylic models are harder on the outside and softer on the inside, so they're durable and more comfortable," says Dr. Gordon. Practicing relaxation techniques, like five minutes of deep breathing before bed, can also help nix the gnashing.

Price point: Mouth guards are not generally covered by insurance, so be prepared to pay $400 to $800. On the plus side, they tend to last 5 to 10 years.

Discoloration

What turns your pearly whites yellow? Blame dark and acidic food and drink, such as red wine, coffee, tea, colas, chocolate and even marinara sauce. Putting off a dental appointment isn't wise, because stains are easier to remove early on, when they're closest to the surface, says Debra Glassman, D.D.S., a cosmetic dentist in New York City.

The good news: You can make your smile eight to 16 shades lighter with one in-office, light-activated whitening procedure, like Kor, Zoom or Brightsmile. "When these first came out, the process took an hour and a half, and many people experienced tooth sensitivity afterward," says Dr. Glassman. "Now, because the lights are stronger, it takes only 45 minutes and sensitivity is less common." Home whitening kits (like strips or molds) are cheaper alternatives that can help too. But teeth may only get a few shades whiter, says Dr. Glassman, and you also need to use kits twice a day for two weeks. To give your teeth a mild brightening, brush with a whitening toothpaste after meals.

Price point: An in-office procedure will run you about $600 and isn't covered by insurance since it's cosmetic. Whitening kits usually cost $20 to $40.

Gum Disease

Plaque buildup can inflame the gums, causing gum disease. "The number one warning sign is bleeding after brushing or flossing," says Connie White, D.D.S., a dentist in Kansas City, Missouri, and a spokesperson for the Academy of General Dentistry. In the early stages, a thorough cleaning might be all you need. But if the problem is left unchecked, it can progress to
periodontitis, a more severe form that can lead to tooth loss and increase your risk for cardiovascular disease.

The good news: The treatment—a nonsurgical procedure called scaling and root planing—is much more tolerable than it used to be. At two separate appointments a dentist or hygienist will numb your mouth and remove irritants from under the gums. Thankfully, scraping the teeth with metal picks is pretty much a thing of the past. New ultrasonic vibrating tools are more likely to be used. They speed up the process and don't make that cringe-inducing noise.

Price point: Scaling and root planing costs $200 to $500 per quarter of the mouth. Insurance companies generally foot at least half of the bill, because it's considered preventive care.

Breakage

Decay, an injury and even eating something hard may all lead to a chipped tooth. Don't wait to get it repaired, because even a minor fracture can irritate the mouth. Plus, it makes the tooth more susceptible to further breakage. If possible, put the part that falls off in a glass with milk and call the dentist immediately. She may be able to re-attach it if she can see you within 30 minutes to an hour.

The good news: Dental lasers and air abrasion can painlessly take care of fillings or bonding. Those who need a crown or veneer have it easier as well. Patients often receive same-day treatment thanks to computer-assisted manufacturing of the new covering. Giving an impression is less of a hassle now too—the claylike material tastes better and sets faster. In some practices, that process can even be replaced by simply taking photos.

Price point: A filling usually costs $100 to $300, a crown can run from $800 to $2,000, and the price of a veneer ranges from $800 to $2,500. Insurance almost always takes care of fillings and pays about 50% for crowns, but veneers are rarely covered. How much your plan will pay depends largely on the material you choose (such as silver, gold or porcelain).

Tooth Truth

Brushing for two minutes (in the morning and at night) and flossing daily are still the two best preventive measures.

Fear Factor

Scared of the dentist? Try these easy, calming tricks.

Minimize the surprise
Have your dentist explain exactly what she plans to do ahead of time, including what tools she will use, how long the procedure will last and which parts may hurt more than others.

Develop a signal
Create a nonverbal gesture, like raising your hand, so you can alert the dentist anytime you feel pain.

Weigh your options
If your treatment requires anesthesia but you're needle-phobic, ask about electrical anesthesia, which sends numbing pulses through small sponges placed in the mouth or on the face. Or request nitrous oxide—laughing gas that leaves you sedated.

Break it up
If the procedure is going to last awhile, ask if it's possible to take short breaks at regular intervals.

Distract yourself
Some practices have TVs; otherwise, bring a portable music player and headphones.

Originally published in the October 1, 2011, issue of Family Circle magazine.

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